Hepatic Trauma Interventions

Pillai, Akshita S.; Kumar, G.; Pillai, Anil K.

doi:10.1055/s-0041-1724014

Cited by 14 publications

(22 citation statements)

References 8 publications

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“…Liver trauma grading ranges from I to V based on severity of injury and a variety of imaging characteristics. For most liver trauma grades with hemodynamic stability, nonoperative management (NOM) is the mainstay of treatment with angiointervention/angioembolization as an indicated complement to NOM 1,5–8. Operative management is typically indicated in patients who are hemodynamically unstable or have signs of peritoneal irritation, free intraperitoneal air or fluid, or evidence of high-energy penetrating trauma on imaging (CT) 1,4–8…”

Section: Liver Traumamentioning

confidence: 99%

“…1,5 Diagnosis of hepatic trauma can be made with ultrasound in cases of hemodynamic instability to evaluate bleeding into the peritoneal or pericardial space; however, accuracy may be suboptimal 1,5 and CT with IV contrast and dual-phase imaging is the gold standard for imaging in hemodynamically stable patients and can elucidate active extravasation with delayed phase imaging. 1,[5][6][7] Any trauma to the anterolateral abdominal or thoracic wall should be assessed for liver trauma. 6 This should especially be considered in pediatric patients as their smaller size predisposes to greater likelihood of solid organ injury.…”

Section: Liver Traumamentioning

confidence: 99%

“…1,[5][6][7] Any trauma to the anterolateral abdominal or thoracic wall should be assessed for liver trauma. 6 This should especially be considered in pediatric patients as their smaller size predisposes to greater likelihood of solid organ injury. 7 Liver trauma grading ranges from I to V based on severity of injury and a variety of imaging characteristics.…”

Section: Liver Traumamentioning

confidence: 99%

See 2 more Smart Citations

Solid Organ Injury Grading in the Abdomen: A Primer for Emergency Radiology

Roth¹,

Meraz²,

Bui³

et al. 2023

Contemporary Diagnostic Radiology

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The American Association for the Surgery of Trauma (AAST) established the Organ Injury Scale (OIS) in 1984, making an initial revision in 1994, and the most recent revision in 2018. This recent revision was made to better predict the need for operative or angiointervention management, considering active hemorrhage or other vascular complications. Diagnosis of hemodynamically stable patients is made by CT; however, hemodynamically unstable patients may be diagnosed via focused assessment with sonography in trauma (FAST) ultrasound or emergency laparotomy. [1][2][3] In this article, we discuss in depth the different OIS gradings for renal, hepatic, and splenic trauma and demonstrate the necessary information that an emergency radiologist must know through a series of cases. This knowledge will allow radiologists to concisely communicate with referring teams and

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Section: Liver Traumamentioning

confidence: 99%

Section: Liver Traumamentioning

confidence: 99%

Section: Liver Traumamentioning

confidence: 99%

See 1 more Smart Citation

Solid Organ Injury Grading in the Abdomen: A Primer for Emergency Radiology

Roth¹,

Meraz²,

Bui³

et al. 2023

Contemporary Diagnostic Radiology

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“…However, arterial injury may still produce a blush, and angioembolization of arterial source of bleeding may then be pursued for hemorrhage control. A strategy of selective or supra-selective embolization techniques to the injured vessels may be used [ 23 , 24 ], but more centrally located or named vessels should be avoided for total occlusion and subsequent ischemia. Given the dual supply by the liver (portal and arterial), even extensive embolization may be well tolerated.…”

Section: Adjunct Role Of Angioembolization To Operative Managementmentioning

confidence: 99%

Management of severe liver injuries: push, pack, pringle – and plug!

Kanani

Sandve

Søreide

2021

Scand J Trauma Resusc Emerg Med

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Rupture of the liver is fortunately an accident not often met with, but one which, when it is seen, may be associated with a condition of the patient as serious as anyone can meet within surgical practice" [1].These are the introductory words of the article by the Glasgow surgeon J. Hogart Pringle, written over a century ago, that would describe the clinical and experimental attempt at surgical control of severe liver lacerations by means of clamping the vessels in the hepatoduodenal ligament [1]a procedure since referred to by the eponymous "Pringle's manoeuvre" (Fig. 1). Notably, Pringle himself noted in his seminal paper that in severe cases of bleeding the only right thing to do was to pack. Hence, the surgical dogma for managing severe bleeding of the liver has been to Push (to approximate the rough wound-edges towards each other for compression), Pack (to ensure tight packing and compression of the liver parenchyma) and Pringle (to temporize and reduce the inflow of the portal vein and hepatic artery to the liver). This surgical dogma has been taught for decades, yet with high mortality rates for patients suffering severe hepatic lacerations and bleeding. However, since the emergence and widespread use of cross-sectional imaging by computed tomography in the 1980s and 1990s, the emergence of nonoperative management has slowly and steadily increased for all solid organ injuries [2][3][4]. Added to this is the increased understanding of injury pathophysiology and haemodynamics with appropriate resuscitation measures [5,6], better organized trauma care and structured team training [7], and

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“…The second most commonly involved solid organ (after spleen) to be injured in blunt abdominal trauma is the liver because of its location and its relationship with other structures in the abdomen [ 2 ] and liver injury is the most common cause of death in such trauma with a 10–15% mortality rate [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

Primary angioembolization in liver trauma: major hepatic necrosis as a severe complication of a minimally invasive treatment—a narrative review

et al. 2022

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The liver is the second most commonly solid organ injured in blunt abdominal trauma. Liver injuries are classified according to the American Association for the Surgery of Trauma Injury Scale. The choice of Non-Operative Management is based on generalized clinical patients’ conditions combined with the evidence on CT scan imaging. To date, there are no consensus guidelines on appropriate patient selection criteria for those who would benefit from angiography and angioembolization. Major hepatic necrosis is a clinical condition of extended liver damage and is the most common complication after angioembolization. Large amounts of necrotic liver require therapy, but it is unclear if the better technique is debridements supplemented by percutaneous drainage procedures or definitive resection. A systematic review of the literature was performed with a computerized search in a database such as Medline for published papers on the use of angioembolization in trauma patients with hepatic injuries and on the most common complication, the major hepatic necrosis. The systematic review was conducted according to the recommendations of the 2020 updated Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. A total of 3643 patients were included in the study, suffering liver trauma and 1703 (47%) were treated with Non-Operative Management; angioembolization was performed 10% of cases with a variable rate between 2 and 20%. Patients developed different complications. Hepatic necrosis accounted for 16% ranging from 0 to 42%. 74% of patients underwent operative management with a mortality rate of 11%. High-grade liver injuries pose significant challenges to surgeons who care for trauma patients. Many patients can be successfully managed nonoperatively. In hemodynamically stable patients with arterial blush, without other lesions requiring immediate surgery, selective and super-selective AE of the hepatic artery branches is an effective technique. However, these therapies are not without complications and major hepatic necrosis is the most common complication in high-grade injures. Level III, Systematic review

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Hepatic Trauma Interventions

Cited by 14 publications

References 8 publications

Solid Organ Injury Grading in the Abdomen: A Primer for Emergency Radiology

Solid Organ Injury Grading in the Abdomen: A Primer for Emergency Radiology

Management of severe liver injuries: push, pack, pringle – and plug!

Primary angioembolization in liver trauma: major hepatic necrosis as a severe complication of a minimally invasive treatment—a narrative review

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